Module 5 Diagnostic tests

Global Programme to Eliminate Lymphatic Filariasis (GPELF)
Training in monitoring and epidemiological assessment of mass
drug administration for eliminating lymphatic filariasis
TAS
Module 5 Diagnostic tests
Module 5 Diagnostic tests
Learning objectives
By the end of this module, you should understand how to:
1. procure diagnostic tests
2. collect blood
3. prepare, conduct and interpret ICTs
4. prepare, conduct and interpret the Brugia RapidTM tests
Slide 2
Module 5 Diagnostic tests
Overview

Diagnostic tests for TAS

Procurement of diagnostic tests

Blood collection techniques

Standard operating procedures for diagnostic tests:
 W. bancrofti – ICT
 Brugia spp. – BrugiaRapid™
Slide 3
Module 5 Diagnostic tests
Diagnostic tests for TAS
Mapping
MDA
Surveillance
Fail
Yes
TAS
Mf or Ag≥1%
Baseline
Mid-term
(optional)
Pass
Follow-up
[Eligibility]
M&E
Assessment tools
Mapping
Blood film or
ICT
Slide 4
MDA
Blood film or ICT
Module 5 Diagnostic tests
TAS
Surveillance
ICT or
Brugia
RapidTM
test
ICT or Brugia RapidTM test
Potential for future use:
Antibody, xenomonitoring
Diagnostic tests for TAS
 Areas endemic for W. bancrofti: ICT
 Areas endemic for Brugia spp.: Brugia RapidTM test
 Areas endemic for both W. bancrofti and Brugia spp.:
both diagnostic tests, with testing evaluated
separately against critical cut-offs
Slide 5
Module 5 Diagnostic tests
Diagnostic tests for TAS
Field assay
Detection target
Blood film
Microfilariae
ICT
Filarial antigen
Brugia RapidTM test Antifilarial antibody
Slide 6
Module 5 Diagnostic tests
Procurement of diagnostic tests
 ICT
 BinaxNow® Filariasis – manufactured by Alere, Inc
(Scarborough, Maine, USA)
 A “no objection certificate” is required for importation of
the test devices.
 Positive control can be obtained from the Filariasis
Research Reagent Repository Center
(www.filariasiscenter.org)
 Brugia RapidTM test
 Manufactured by Reszon Diagnostics International
(Selangor, Malaysia)
Slide 7
Module 5 Diagnostic tests
Quality control
 Training should be conducted before a TAS to ensure that
all protocols are followed properly.
 The pouch should be opened just before use.
 Diagnostic tests should be tested with a positive control
to ensure their validity.
 Diagnostic tests should be stored properly to minimize
the risk for compromising their quality.
 Any indeterminate test result should immediately be
read by a second reader or supervisor and the test
repeated if necessary.
Slide 8
Module 5 Diagnostic tests
Blood collection technique
1
2
Clean the finger to be pricked
with an alcohol swab, and
allow finger to dry.
Prick the internal side of the
finger with a sterile lancet.
4
4a
3
Safely discard the lancet.
4b
Collect the blood (4a) into a calibrated capillary tube coated with an anticoagulant or (b) onto
filter paper according to the survey method. If collecting into tubes, collect slightly more than
the required volume of blood in case of clotting or spillage.
Slide 9
Module 5 Diagnostic tests
ICT
 Sensitive for detecting W. bancrofti antigen.
 Do not require laboratory equipment and can be
processed quickly.
 Positive result indicates the presence of adult worm
antigen.
 Adequate training is necessary to reduce interobserver variation and to reduce misreading of cards,
which can lead to false-positive results.
Slide 10
Module 5 Diagnostic tests
ICT: Preparation
 Storage – Cards have a limited shelf-life at ambient temperature (3
months at 30 °C) but a longer shelf-life when stored at 4 °C (about 9
months). Cards should not be frozen.
 Testing with a positive control – Before a field survey is begun, two
cards from each lot should be tested with a weak positive control, which
can be obtained from the Filariasis Research Reagent Repository Center
(www.filariasiscenter.org). With this control, the test line may be very
faint. Do not use cards that give a negative result when tested with the
control.
 Transport – A cool box is not required for transporting cards for use in
the field; however, care should be taken not to expose cards to extreme
heat for long periods.
 Light – Cards must be read under adequate lighting, as faint lines can be
difficult to see. This is especially important when reading cards at night.
Slide 11
Module 5 Diagnostic tests
ICT: Procedure
1
Remove card from
pouch just before use.
Collect 100 µl of blood by
finger prick into a calibrated
capillary tube or remove 100
µl of blood from a
microcentrifuge tube with a
micropipette. Do not add
blood directly from the finger
to the card.
2
Slide 12
Module 5 Diagnostic tests
ICT: Procedure
3
Add blood sample slowly
to the white portion of the
sample pad.
Do not add blood directly
to the pink portion of the
sample pad.
4
Do not read cards
if the plasma has
not flowed all the
way down the
strip.
Remove adhesive liner
and close card. Start
timing.
Slide 13
Do not close the card before the
sample migrates to the pink portion
of the sample pad (takes about 30
seconds after addition of blood).
It is helpful to record
the starting time on the
front of the card.
Module 5 Diagnostic tests
If plasma fails to migrate completely
past the bottom of the window, a
false-positive result may be read.
ICT: Procedure
5
Read test
results 10
minutes
after closing
card.
Circle the appropriate
result on the front of the
card to create a
permanent record.
Slide 14
Module 5 Diagnostic tests
Do not read
cards at any
time other than
10 minutes, as
the reading
may be falsepositive.
ICT: Interpretation
Positive
Positive
(weak)
Negative
T = test
C = control
Invalid
No lines appear
Invalid
No control line
Negative
The test line should be pink. Sometimes, a grey line
or shadow appears in the test line position. This
should not be misinterpreted as a positive result.
Slide 15
Module 5 Diagnostic tests
Brugia RapidTM test
 Sensitive for detecting antibodies to B. malayi and B.
timori.
 Does not require laboratory equipment and can be
processed quickly.
 Positive result indicates the presence of antifilarial
antibodies.
Slide 16
Module 5 Diagnostic tests
Brugia RapidTM test: Preparation
 Storage – The test has a shelf-life of 18 months when stored at
ambient temperature (20–25 °C); 4 oC (refrigeration) is recommended
for long-term storage. The tests should not be frozen.
 Transport – A cool box is not required, although it is desirable, when
transporting tests for use in the field. Care should be taken not to
expose the tests to extreme heat for long periods.
 Lighting – Tests must be read under adequate lighting, as faint lines
can be difficult to see. This is especially important when reading tests
at night.
 The test requires 30 µl of serum or plasma or 35 µl of whole blood.
Slide 17
Module 5 Diagnostic tests
Brugia RapidTM test: Procedure
1
Bring test cassette and chase
buffer to room temperature.
Remove cassette from foil pouch
just before use. Label the cassette
with information on the sample.
2
Slide 18
Collect 35 µl of blood by finger
prick into a calibrated capillary
tube or remove 35 µl of blood
from a microcentrifuge tube
with a micropipette. Do not
add blood directly from the
finger to the cassette.
Module 5 Diagnostic tests
Brugia RapidTM test: Procedure
3
Add blood sample slowly
to the square well by
touching the capillary
tube or pipette tip to the
sloping side.
If using serum or
plasma, only 30 µl are
needed.
Slide 19
Add one drop of chase
buffer to the same
square well.
If using serum or
plasma, no chase
buffer is required.
Module 5 Diagnostic tests
The sample will start to flow
up the strip. The cassette can
be tapped gently on the table
to facilitate the flow. Wait until
the sample has reached the
blue line (A).
If the sample does not reach
the blue line (A) after 4
minutes but has reached area
B, proceed to the next step.
Brugia RapidTM test: Procedure
4
When the sample has
reached the blue line (A),
add three drops of chase
buffer to the circle well at
the top of the cassette.
Add the buffer drop by
drop, and allow each drop
to saturate the pad before
delivering the next drop.
Slide 20
Module 5 Diagnostic tests
Firmly pull the clear tab
at the bottom of the
cassette until you feel
resistance.
After pulling the clear
tab, add one drop of
buffer to the square well.
Brugia RapidTM test: Procedure
5
Start timing. Read test results 25
minutes after adding the final drop
of buffer.
Record the start or end
time on the front of the
cassette.
Test results for serum and plasma
samples should be read after 15
minutes.
Write the appropriate result
on the front of the cassette
to create a permanent
record.
Slide 21
Module 5 Diagnostic tests
Brugia RapidTM test: Interpretation
A
B
C
Positive
B and C lines present
Positive (weak)
B and C lines present
Negative
B line appears; no C line present
A = blue line
B = control
C = test line
The intensity of
the blue line
does not affect
the reading.
Slide 22
Invalid
No B and C lines
present
Module 5 Diagnostic tests
Invalid
No B line present;
C line appears
Invalid
Blood did not clear
Exercise
1. Practise finger-prick blood collection.
2. Observe use of positive controls to ensure the validity
of the diagnostic test(s).
3. Practise using the diagnostic test(s) approved for
transmission assessment surveys in your country or
area.
Slide 23
Module 5 Diagnostic tests